Chandana Papudesu, Cat N. Burkat, Heather A.D. PotterRead More
An 82-year-old woman presented with painless right upper and lower eyelid swelling, erythema, and ptosis of 3 weeks duration (Fig A). There was no improvement with antibiotics for presumed cellulitis. A palpable mass was noted on referral, and anterior orbitotomy revealed an infiltrative, un-encapsulated mass within the preaponeurotic fat. Biopsy showed histiocytoid cells stacked in cords (Fig B, bracket) and signet-ring cells (Fig B, arrow). Immunohistochemistry was suggestive of breast cancer or signet-ring cell gastric carcinoma. Mammography showed a breast mass, which when biopsied demonstrated tumor cells similar to those of the orbital mass (Fig C, arrow). Metastatic breast cancer should be considered when inflammatory or infiltrative symptoms are present in middle-aged to elderly women. (Magnified version of Fig A-C is available online at www.aaojournal.org).